Chronic pelvic pain: comorbidity between chronic musculoskeletal pain and vulvodynia.

Chronic pelvic pain (CPP) is a common condition that has a major impact on the quality of life of both men and women. Male CPP is usually attributable to well-defined urogenital conditions (most frequently infectious/non infectious prostatic diseases) or musculoskeletal or bowel diseases, whereas the features of female CPP are much more complex and are of particular clinical and epidemiological importance. It is a multifactorial syndrome that can be due to diseases of the urogenital, gastrointestinal, or musculoskeletal systems, or to neurological or neuropsychiatric disorders. It is not always easy to identify its predominant pathogenesis, although it often occurs as a central sensitization syndrome triggered by an initial stimulus which is no longer detectable and only manifests itself clinically through pain. In this respect, there are some very interesting relationships between vulvodynia and fibromyalgic syndrome, as identified in a preliminary study of women with chronic musculoskeletal pain in which it was demonstrated that vulvar pain plays an important role, although it is often overlooked and undiagnosed.

Evaluation of vestibular biopsy features in patients affected by fibromyalgia, by vulvodynia or by their association.

OBJECTIVE: To evaluate the histologic features of vestibular biopsies from patients affected by fibro myalgia (FM), or vulvodynia (VD), or the their association (FM-VD) in order to facilitate differential diagnosis among conditions that present sexual pain with similar clinical characteristics. STUDY DESIGN: Fourty-four women already diagnosed with FM were recruited to evaluate the presence of sexual pain not owing to FM. Fourteen women affected by sexual pain of unknown origin who came to our department requesting treatment were also recruited. All subjects were interviewed regarding their history of pain and examined in order to exclude vaginal conditions. Sexual pain did not show the characteristics of VD in 18 FM women; in the remaining 22 women VD resulted as associated with FM. All fourteen self-referred women were diagnosed with VD. All subjects underwent a posterior vestibular biopsy at the fourchette under local anesthesia. Tissue specimens were processed for histologic examination and immunostained for S-100protein and CD34. Statistical analysis was performed with the Pearson's Chisquare test. RESULTS: Data analysis showed a statistically significant prevalence of inflammation in the VD group. Analysis of the histologic features showed that the concomitant presence of inflammation, nerve bundles, and fibrosis (often mild) is prevalent in VD. Fibrosis is highly frequent and often moderate/severe in FM and it is rarely associated to inflammation and nerve bundles. FM-VD women show intermediate grading. CONCLUSIONS: Our findings show different histologic characteristics in vestibular biopsy in patients affected by Fibro Myalgia, by Vulvodynia or by their association that could be useful to facilitate the differential diagnosis between conditions of sexual pain with similar clinical characteristics.

Diabetes, psychological function and male sexuality.

The aim of the study was to assess psychological contributors or correlates of sexual dysfunction in diabetic men. The study was conducted on 40 diabetic men and 40 age-matched healthy volunteers. The subjects underwent a psychosexual interview with their sexual partners and had a comprehensive medical evaluation to rule out the confounding effects of other illnesses or medications. Psychiatric, psychological and marital information was obtained with the Schedule for Affective Disorders and Schizophrenia (SADS-L), the SCL-90-R, the Derogatis Sexual Function Inventory, the Locke-Wallace Marital Adjustment test and the Dyadic Adjustment Inventory. Compared to controls, diabetic patients had significantly lower levels of erotic drive, sexual arousal, enjoyment and satisfaction. Problems in these areas coexisted with alterations in sexual attitudes and body image but were not related to group differences in marital adjustment as reported separately by the patients and their partners. There was no evidence that psychological distress or psychiatric disorders are associated with diabetes or with its effects on sexual function.

The evaluation of some factors influencing the sexual life of women affected by breast cancer.

Although there is clinical evidence that cancer patients become less interested in sexuality and develop some difficulties in sharing feelings and thoughts with their spouses, systematic information on the factors influencing intimacy are lacking. The aim of this study is to explore the importance of variables such as reaction to illness and scarring, and marital satisfaction on the patients' capability to resume an enjoyable sexual life following surgery and radiation for the treatment of their tumors.

Effects of androgen treatment in impotent men with normal and low levels of free testosterone.

The relation between sexual function and serum free testosterone (fT) levels, which represent the active fraction of circulating testosterone, was evaluated. Two groups of impotent male subjects with mild hypogonadism were treated with oral testosterone undecanoate (TU); these men presented with tT/luteinizing hormone (LH) ratio and tT levels at the lower limits of normal. The first group had serum fT below 6.6 ng/ml, considered the lower normal value, according to our laboratory method, whereas the second group had normal fT limits. Administration of TU improved sexual function only in impotent men with low fT levels, but not in subjects with normal fT levels, even though the tT levels and the tT/LH ratio of the two groups were not significantly different. The results of our study suggest the presence of a minimum serum fT threshold, lying near the lower normal range, which determines the male sexual function. Moreover, serum fT levels were a more sensitive index than tT for identifying impotent men who can be successfully treated with androgens.

Sexual behavior of men with isolated hypogonadotropic hypogonadism or prepubertal anterior panhypopituitarism.

Sexual behavior of men with secondary hypogonadism was studied. Seven of the thirteen subjects presented with hypogonadism secondary to isolated gonadotropin (Gn) deficit, whereas the other six had idiopathic prepubertal anterior panhypopituitarism. Testosterone (T) levels were low and did not differ between the two groups. All subjects were evaluated both during replacement therapy (Gn in the first group; Gn plus cortisone and thyroxine in the second group) and 2 months after withdrawal of Gn therapy. During and after withdrawal of Gn administration, men with isolated deficit of Gn retained sexual activity and nocturnal penile tumescence, although they were partially compromised compared with a control group; on the other hand, panhypopituitarics reported compromised sexual function during Gn treatment and no sexual function when Gn therapy was not given. We conclude that different lesions of the hypothalamus-pituitary axis were accompanied by varying degrees of sexual impairment in the two groups of men presenting both secondary hypogonadism and very low T levels.

Low sexual desire in women: the role of reproductive hormones.

The role of reproductive hormones in mediating sexual desire in healthy women is still unclear. Elucidation was sought in this study by comparing the hormonal milieu of two groups of subjects with markedly different levels of sexual desire. Seventeen women ages 27-39 who met DSM III-R criteria for severe, persistent, and generalized loss of desire (hypoactive sexual desire disorder, HSD), but had no other current psychological or medical problem, were compared to 13 healthy, sexually active women. All subjects and spouses were interviewed extensively to determine the women's sexual desire and responsiveness. Blood samples were drawn every 3 to 4 days for one menstrual cycle and were analyzed by RIA for testosterone, SHBG, estradiol, progesterone, prolactin, and luteinizing hormone. Results indicated that the HSD women's gonadal hormones fluctuated normally over the menstrual cycle, were within normal limits for each cycle phase, and were never significantly different from those of controls. Neither testosterone, non-SHBG bound testosterone, nor prolactin differentiated between the HSD women with the most and least severe HSD parameters (e.g., frequency of fantasy, masturbation, or female-initiated coitus), nor between women with lifelong and acquired HSD. The present findings did not provide evidence that reproductive hormones are important determinants of individual differences in the sexual desire of these eugonadal women.

Management of sexual dysfunctions in women.

The deeper understanding of female physiology changed the perspective used to evaluate sexual difficulties. Systems like: vascular, neurological, biochemical, and endocrine are investigated as their modifications for aging or medical conditions may alter the sexual responsivity of women. New data imply that pharmacological interventions may become suitable for women. Gonadal steroids influence mood, wellbeing, and genital physiology but evidence of actions is controversial. Hormone imbalance provokes symptoms that may also derive from other conditions. Clinicians must exclude dismetabolism, depression and family crisis before diagnosing gonadal problems. The female androgen insufficiency syndrome was defined in July 2001 as altered mood, memory and wellbeing, and loss of desire. Estrogen maintains wellbeing and healthy genitals, influencing mood and sexuality. Progesterone provokes tension and nervousness, causing premenstrual syndrome. Hormone replacement is indicated in the treatment of endocrine deficiency. In research projects women receiving one preparation containing androgen reported improvement of mood, and arousal. Sildenafil cures approximately 25% of sexually dysfunctional, menopausal patients; being more effective with hormone replacement therapy (HRT) and consistently active against the block of antidepressants on orgasm. Added to psychiatric regimens, sildenafil ameliorates excitement. Sex therapy helps patients change behavior, overcome anger, communicate needs and redefine sex. We strongly believe that such crucial aspects must be addressed in therapy, even when the etiology is organic.